Provider Demographics
NPI:1396045712
Name:GUIMARAES, TEREA WOOSTER (APRN)
Entity Type:Individual
Prefix:
First Name:TEREA
Middle Name:WOOSTER
Last Name:GUIMARAES
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:81 MAIN ST UNIT 45
Mailing Address - Street 2:
Mailing Address - City:BRANFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06405-3550
Mailing Address - Country:US
Mailing Address - Phone:203-809-6155
Mailing Address - Fax:
Practice Address - Street 1:81 MAIN ST UNIT 45
Practice Address - Street 2:
Practice Address - City:BRANFORD
Practice Address - State:CT
Practice Address - Zip Code:06405-3550
Practice Address - Country:US
Practice Address - Phone:203-809-6155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-02
Last Update Date:2019-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT004537163WC0200X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1396045712Medicaid